tbuckley/cabot-search huggingface dataset:
Abstract 9697: Relation Between Measures of Ventricular Volume/Pressure and Myocardial Damage and Coronary Microvascular Dysfunction Response to Ranolazine
Authors: Anum Asif, Puja K Mehta, Janet Wei, Daniel Berman, Galen C Wiens, Carl Pepine, Noel Bairey Merz
Journal: Circulation (2021)

Introduction: Late sodium channel inhibition with ranolazine may beneficially impact coronary microvascular dysfunction (CMD). We hypothesized that markers of ventricular volume/pressure (N-terminal -pro BNP [NT-proBNP]) and myocardial damage (ultra-high sensitivity cardiac troponin I [u-hs-TnI]) are related to therapeutic response. Methods: We analyzed CMD response in a randomized, double-blind, crossover trial of ranolazine vs. placebo using invasive coronary function testing or non-invasively cardiac magnetic resonance imaging (cMRI) myocardial perfusion reserve index (MPRI). NT pro-BNP and u-hs-TnI values were available in subgroups prior to trial enrollment. Treatment response was change in MPRI (Δ MPRI) or Seattle Angina Questionnaire, angina stability change (ΔSAQ). Spearman correlations and Wilcoxon Rank Sum test were used. Results: Among 128 participants, 12 had NT pro-BNP and 20 had u-hs-TnI available. Median NT pro-BNP and u-hs-TnI were (66 pg/mL) and (0.71 pg/mL), respectively. Higher u-hs-TnI (0.87pg/mL) positively correlated with improved ΔMPRI (Table), but not ΔSAQ (r= 0.03 p=0.80). No significant correlations between NT pro-BNP and ΔMPRI (r= -0.09, p=0.58) or ΔSAQ (r=0.005, P=0.976) were observed. Conclusion: Our study finds that higher u-hs-TnI, a measure of myocardial damage, related to improved cMRI perfusion reserve to the late-sodium channel blocker ranolazine. These results suggest that CMD accompanied by existing myocardial damage, likely secondary to ischemia, may have more favorable response to anti-ischemic therapy. Further studies are needed to validate these results in a larger cohort.
Abstract 13421: Spontaneous Coronary Artery Dissection in Patients With and Without Chronic Systemic Inflammatory Diseases
Authors: Mesfer Alfadhel, Rohit Samuel, Cameron Mcalister, Thomas Nestelberger, Johandra Argote Parolis, Tejana Grewal, Jacqueline Saw
Journal: Circulation (2021)

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction (MI). Chronic systemic inflammatory diseases (CIDs) are common amongst SCAD patients. Whether they contribute to the cause of SCAD or were simply bystanders remain unknown. Methods: We compared the baseline demographics, presentation characteristics and cardiovascular outcomes between patients with and without CIDs in the Canadian SCAD Study. CIDs included systemic inflammatory disorders as well as autoimmune diseases. Patients completed questionnaires along with detailed history of CIDs. Blood biomarkers for inflammation (e.g. C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], white blood cell counts) were obtained at the discretion of the treating physicians. Major adverse cardiovascular events (MACE) were defined as the composite of all-cause mortality, stroke or transient ischemic attack, MI, hospitalization for heart failure and unplanned revascularization. Results: Of 1225 patients with SCAD, 96 (7.8%) had a history of CIDs. Patients with CIDs were of similar age (52.5 vs.51.8 yrs, p=0.51), but were more likely to be women (96.9% vs 89.2%, p=0.02). There were no significant differences in baseline demographics, ECG, or angiographic findings between CID or non-CID cohorts. Among patients with biomarkers performed, there was no difference in CRP (9.6 vs. 12.9mg/L, p=0.54), ESR (10 vs. 13.9, p=0.42), white cell count (12.6 vs. 11.3, p=0.80), neutrophil count (5.1 vs. 5.6, p=0.70), or lymphocyte count (1.7 vs. 2.0, p=0.41), in CID versus non-CID groups, respectively. The proportion of patients treated conservatively or with revascularization were not different between groups. At median follow up of 3.0yrs (IQR 2.0-3.8), in hospital and overall MACE were not significantly different between CID and non-CID patients (8.4% vs. 6.1%, p=0.38) and (23% vs. 16.8%, p=0.12), respectively. Conclusion: In our large SCAD cohort, there were no significant differences in presentation or outcomes in SCAD patients with or without CID. Importantly, there was no difference in levels of inflammatory biomarkers, supporting the hypothesis that active inflammation was not an important contributor of SCAD.
Abstract 12519: Electrocardiographic Findings and Arrhythmias in Patients With Familial ST-Depression Syndrome
Authors: Alex H Christensen, Christoffer Vissing, Sofie Villumsen, Adrian Pietersen, Jacob Tfelt-hansen, Thomas Jensen, Morten Olesen, Steen Pehrson, Finn L Henriksen, Niels Sandgaard, Kasper Iversen, Henrik Jensen, Henning Bundgaard
Journal: Circulation (2021)

Background: The recently reported Familial ST-depression syndrome is a distinct inherited cardiac disease entity characterized by persistent, non-ischemic ST-depressions and risk of arrhythmias and heart failure. We aimed at further characterizing the features associated with the syndrome. Methods: Retrospective analysis of demographics, electrocardiographic, arrhythmic and imaging data from families with Familial ST-depression syndrome in Denmark. Results: Forty affected individuals (43% men; mean age at diagnosis 49.1 years) from 14 apparently unrelated families with ≥2 affected members were included. Pedigree analyses were consistent with autosomal dominant inheritance in all families. The ST-depressions were most pronounced in leads V4, V5, and II and persisted over time (mean follow-up 9.3 years), i.e. no temporary normalization was seen. The ECG phenotype seemed to develop in pre-puberty. Exercise accentuated the ST-depressions with a maximum difference between rest/stress (mean) of -117μV in lead V5. Six (15%) patients developed ventricular arrhythmias or (aborted) sudden cardiac death, seven (18%) were diagnosed with left ventricular ejection fraction ≤50%, and 10 (25%) developed atrial fibrillation. Seven patients had at least one catheter ablation; five for supraventricular arrhythmias and two for ventricular arrhythmias. Males experienced more arrhythmic endpoints than females (Figure, p&lt;0.01). Surprisingly, in some of the patients the ECG phenotype was tolerated for decades before events occurred. Conclusions: We identified 14 families with the novel syndrome showing autosomal dominant inheritance. The phenotype was associated with arrhythmias, aborted sudden cardiac death, or heart failure in about half of the cases. Families with Familial ST-depression syndrome should undergo cascade screening like in other inherited arrhythmia syndromes.
Abstract 13825: Characteristics of Patients With Exercise-Induced Left Ventricular Systolic Dysfunction and Non-Significant Coronary Artery Disease
Authors: Scott A Hubers, Akanksha Mohananey, Naveen L Pereira
Journal: Circulation (2021)

Introduction: Prior studies have shown 30-35% of patients with an abnormal stress test had non-obstructive coronary artery disease. The characteristics and outcomes of this patient population have not been well studied. We tested the hypothesis that there is a distinct group of individuals who have an exercise-induced cardiomyopathy not related to the presence of obstructive coronary artery disease or pre-existing structural heart disease. Methods: Our cohort included adults 18 years and older who underwent stress echocardiography at the Mayo Clinic. Patients were included if their resting left ventricular ejection fraction (LVEF) was greater than 50% and decreased by more than 5% to under 50% with exercise. We excluded patients who did not have coronary angiography in the 90 days following stress echocardiography and those with prior diagnosis of coronary artery disease or structural/valvular heart disease. Results: A total of 205627 stress echocardiograms were performed between 2003 and 2019, of which 127 patients were analyzed in our cohort. The median age was 68 years, and 76% were female. The median LVEF was 55% at rest and 45% with stress. Left bundle branch block was present in 9% of patients. Median peak systolic blood pressure was 174 mm Hg. Stress electrocardiogram was positive in 14% of patients. Median functional aerobic capacity [interquartile range] as a percentage of age/sex predicted capacity was 101% [73%, 117%]. Conclusion: We describe a cohort of patients with exercise-induced left ventricular systolic dysfunction not explained by obstructive coronary artery disease or structural heart disease. Forthcoming analyses of long term outcomes will be important to understand how these patients compare to patients without exercise-induced cardiac dysfunction.
Abstract 9608: Overuse of Cardiac Evaluation and Testing in Patients at Low Cardiac Risk Prior to Laparoscopic Bariatric Surgery
Authors: Brandon R Peterson, Olivia Calisi, Catherine Caldwell, Steven King, Daniel Berger, Alyson Rich, Yongwook Dan, Umer Qureshi, Shayann Ramedani
Journal: Circulation (2021)

Introduction: Preoperative cardiac testing is common prior to bariatric surgery despite the low incidence of postoperative cardiac events. We sought to determine what proportion of patients who underwent preoperative cardiac testing and evaluation prior to laparoscopic bariatric surgery were at low cardiac risk. Methods: We reviewed preoperative cardiac testing and evaluations performed for patients undergoing laparoscopic bariatric surgery at Hershey Medical Center from January 1 st 2015 through December 31 st 2019. Cardiac risk was evaluated using the Revised Cardiac Risk Index (RCRI) and the National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest risk calculator (NSQIP MICA). Patients with a RCRI score ≤1, or a NSQIP MICA cardiac risk estimate less than 1%, were considered to be at low cardiac risk. Results: 1,134 patients underwent laparoscopic bariatric surgery during the study time period, of which 1,093 (96.4%) were low cardiac risk by RCRI and 1,133 (99.9%) were low cardiac risk by NSQIP MICA. 587 patients (51.8%) were referred to cardiology for preoperative evaluation. 643 patients (56.7%) underwent one or more preoperative cardiac tests (see figure for breakdown of cardiac risk for each cardiac evaluation). Out of 1,134 patients, 1 (0.1%) had myocardial infarction within 30 days of surgery. There were 0 patients with either cardiac arrest or death within 30 days of surgery. Conclusions: A large majority of patients undergoing cardiac evaluation and testing prior to laparoscopic bariatric surgery were at low cardiac risk, regardless of whether cardiac risk was assessed by the RCRI or by the NSQIP MICA. Preoperative cardiac testing and evaluation were common despite excellent cardiac outcomes. Use of tools such as the RCRI or NSQIP MICA to identify patients at low cardiac risk at the time of bariatric enrollment may help to reduce the overuse of preoperative cardiac evaluation and testing in low risk patients.
Abstract 8943: Type 2 Diabetes and Risk of Major Cardiovascular Events in Peripheral Artery Disease versus Coronary Artery Disease Patients
Authors: Christoph H Saely, Alexander Vonbank, Barbara Larcher, Arthur Mader, Maximilian Maechler, Lukas Sprenger, Beatrix Mutschlechner, Magdalena Benda, Andreas Leiherer, Axel Muendlein, Heinz Drexel
Journal: Circulation (2021)

Introduction: The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. Hypothesis: We hypothesize that the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM). Methods: We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). Results: When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p&lt;0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p&lt;0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p&lt;0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14-1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27-1.98], p&lt;0.001). Conclusions: In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE.
Abstract 13415: Initial Diuretic Dosing and Length of Stay in Patients Hospitalized for Congestive Heart Failure
Authors: Steven M Bradley, Chelsey Thomas, Pam Rush, Shaina Madrid, Craig Strauss
Journal: Circulation (2021)

Background: Among patients hospitalized for heart failure, a prior randomized trial suggests the initial dose of diuretics may have implications on time to decongestion and length of hospital stay. Little is known about the dosing of intravenous loop diuretics in routine clinical practice and the association between diuretic dosing and hospital length of stay. Methods: We identified 12,209 patients admitted with heart failure at 12 Allina Health hospitals in central Minnesota and western Wisconsin between January 1, 2017 and December 31, 2020. We excluded patients on observational status, no or unknown home loop diuretic dosing, no intravenous loop diuretic within 24 hours of admission, and patients who received inotropes or dialysis within 24 hours of admission. Initial diuretic dose was compared to home dose in furosemide equivalents using the Diuretic Strategies in Patients with Acute Decompensated Heart Failure trial logic and categorized into below home dose, equivalent to home dose, or above home dose. We describe patient characteristics and length of stay by category of initial diuretic dose. Results: Among 3,580 admitted for heart failure, initial diuretic dose was below home dose in 555 (15%) patients, equivalent to home dose in 756 (21%) patients, and above home dose in 2269 (64%) patients. Baseline characteristics by category of initial diuretic dose are presented in the Table. Mean length of stay was longest in patients receiving a diuretic dose that was below home dose (6.4 days) and shortest in patients receiving a dose above home equivalent (5.0 days) (Table). Conclusions: In a cohort of patients admitted for heart failure, more than 1 in 3 patients received an initial dose of intravenous loop diuretics that was equivalent to or below their home diuretic dose and this was associated with a longer length of hospital stay. These findings may represent a quality improvement opportunity in the care of patients hospitalized for heart failure.
Abstract 8941: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients
Authors: Takashi Nagasaka, Noriaki Takama, Norimichi Koitabashi, Kazufumi Aihara
Journal: Circulation (2021)

Introduction: Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has few evidence about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease. Hypothesis: The aim in this study is to assess the effectiveness and safety of resuscitation strategies using MCC versus resuscitation strategies using standard manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease. Methods: We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions at our hospital. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device (LUCAS® Lund University Cardiac Arrest System, USA) during the resuscitation. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group). Results: There was no significant difference in age, gender, the rate of bystander CPR, and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups (manual group 42.8% vs MCC group 50.1% p=0.13). However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated for cardiac arrest or refractory cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (manual group 26.8% vs MCC group 39.1% p=0.014). Conclusions: This study showed that mechanical chest compression in cardiac arrest and cardiogenic shock increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.
Abstract 13463: Tricuspid Regurgitation Referral Population Characteristics
Authors: Matthew Lawlor, Vivian Ng, Shaan Ahmed, Lyle Dershowitz, Claudia Boyle, Torsten Vahl, Tamim Nazif, Nadira Hamid, Omar Khalique, Martin Leon, Isaac George, Rebecca T Hahn, Susheel K Kodali
Journal: Circulation (2021)

Introduction: Advanced tricuspid regurgitation (TR) is associated with adverse cardiovascular outcomes. Herein, we report demographics of patients presenting to a tertiary valve center and characterize measures of TR severity and right ventricular (RV) function. Methods: We conducted a single center retrospective analysis of patients referred to a specialty valve clinic from January 2016 to September 2020 with a primary or secondary diagnosis of tricuspid regurgitation. Baseline clinical, echocardiographic, and hemodynamic variables were evaluated. Results: A total of 348 patients were included. Median age was 79 years (IQR 70, 84), and 54% were female. Torrential TR was present in 41% (n = 146), massive in 11% (n = 40), severe 34% (n = 120), and moderate or less in 9% (n = 31). Increase in TR severity was associated with RV, right atrial, and annular dilatation. There was no difference in RV function between groups assessed by TAPSE or S’. Right atrial pressure v-wave was higher with increase in TR severity. Pulmonary arterial (PA) pressures were significantly different between groups, as was pulmonary vascular resistance (PVR): lower PA pressures and PVR were seen with increase in TR severity. There were no differences in cardiac output across groups, though a numeric trend in decreasing cardiac output was noted with increase in TR severity from severe to torrential. There was increase in S’/PASP and decrease in pulmonary artery pulsatility index seen with increasing TR severity. Conclusion: Patients referred for TR are frequently advanced in age with massive or torrential tricuspid regurgitation and evidence of adverse right ventricular remodeling. Increasing severity of advanced TR was associated with RV hemodynamic decompensation. Preservation of two-dimensional measures of right ventricular function in the setting of progressive TR, as well as markers of right ventricular-vascular coupling, may suggest these are late markers of right ventricular compromise.
Abstract 13458: Obese Heart Failure With Preserved Ejection Fraction Demonstrates Impaired Myocardial Substrate Utilization
Authors: Virginia S Hahn, Zoltan Arany, Min-Soo Kim, Christopher Petucci, Kenneth Bedi, Kenneth B Margulies, Daniel P Kelly, David A Kass, Kavita Sharma
Journal: Circulation (2021)

Introduction: Myocardial fatty acid oxidation is impaired in heart failure with reduced ejection fraction (HFrEF) but increases with obesity with diabetes. HF with preserved EF (HFpEF) patients are often obese, but their myocardial metabolomic profiling compared to HFrEF is unknown. We hypothesized that HFpEF patients have distinctive metabolomics signatures from HFrEF. Methods: Plasma and endomyocardial biopsies were collected from HFpEF patients with clinical HF, LVEF≥50%, and consensus criteria for HFpEF (n=45). Most were obese (median BMI 39.8 kg/m 2 ). Data were compared to end-stage HFrEF (n=30) and unused donor controls (n=20). Liquid chromatography-mass spectrometry measured 97 metabolites (8 organic acids, 30 amino acids [AA], 59 acylcarnitines [AC]). Metabolites undetectable in ≥25% patients were excluded. Statistical analyses used one-way ANOVA with post-hoc Tukey test, and false discovery rate of 5% (Benjamini-Hochberg). Results: Myocardial metabolomics revealed HFpEF patients had greater pyruvate levels vs controls and HFrEF (2-2.5x, p&lt;0.0001). Krebs cycle intermediates were reduced in HFpEF tissue vs controls (succinate, p=0.002; fumarate, p=0.009; malate, p=0.008), while myocardial branched chain AAs (isoleucine, leucine, valine) were greater than both controls (all p&lt;0.0001) and HFrEF (p=0.048, &lt;0.0001, &lt;0.0001, respectively). Short chain ACs downstream of branched chain AA catabolism were reduced in HFpEF tissue vs Controls, whereas long chain ACs that reflect fatty acid oxidation were reduced in both HFpEF and HFrEF tissue vs controls, yet increased in HFrEF plasma. HFrEF had reduced tissue long chain ACs vs HFpEF. Plasma metabolomics replicated myocardial changes in only 11% of metabolites. Conclusions: HFpEF myocardium in obese patients displays metabolic signatures consistent with impaired utilization of fatty acids, glucose, and amino acids in a pattern quite distinct from HFrEF. This is not discerned from plasma metabolomics. These findings identify a unique metabolic phenotype in HFpEF in which obesity and associated insulin desensitization are coupled with compromised fat metabolism and alternate substrate utilization. This likely contributes to metabolic insufficiency in the HFpEF syndrome.